Lampiran 1 Tes Pilih:
HEMATOLOGI FAAL HATI ELEKTROLIT-GAS DARAH Hematologi Lengkap
(CBC, LED, Hitung jenis lekosit)
GOT Na,K,CL (Paket serum)
Golongan Darah A,B,O
& Rh GPT Kalium(serum,Urine 24 jam)
LED Gamma GT Natrium(serum,Urine 24 jam)
Fosfatase Alkali Chlorida(serum, Urine 24 jam)
ANEMIA CHE Calcium Urine
Retikulosit Bilirubin Total Calcium
Besi (*) Bilirubin Direk Calcium Ion
TIBC (*) Protein Total Fosfor Anorganik
Ferritin Albumin Fosfor Anorganik Urine
Transferin TP, Alb, Glob Magnesium(serum,Urine 24 jam
- Grha Vitamin B
12Prealbumin (Transthyretin)
Asam Folat (*) Bilirubin Total (Neonatus) PROTEIN
Gambaran Darah Tepi DIABETES Ceruloplasmin
Gambaran Sumsum
Tulang Glukosa Puasa (*) IgA
Si+TIBC+Formula Glukosa 1 jam PP IgG
FAAL HEMOSTASIS TTGO (*) IgM
Waktu Perdarahan HbA1c (A1c) Free Light Chain(Dharmais) Waktu Pembekuan Glycated Albumin (GA) hs-CRP
Waktu Protrombin Insulin (*) Protein Electrophoresis
APTT Insulin Autoantibody Immunotyping (PRN)
Fibrinogen C-peptide (*) Imunofiksasi Serum (Dharmais)
D-Dimer Anti-GAD Imunofiksasi Urine (Dharmais)
Protein C TIROID
Protein S LEMAK FT3
Retraksi Bekuan Cholesterol Total FT4 Platelet Function Test
Aspirin Cholesterol LDL Direk TSHs
Platelet Function Test
Anti P2Y12 Cholesterol HDL TSH Neonatus - #diskon
Agregasi Trombosit (*) Trigliserida (*) T3 (Total)
ACA IgG Apo A1 T4 (Total)
ACA IgM Apo B TRAb
Anti-Beta2-
Glikoprotein 1 Small-Dense LDL Tiroglobulin
HEMATOLOGI LAIN Lp (a) Anti-Tiroglobulin
Analisis Hb HPLC Adiponektin Anti-TPO
Badan Inklusi HbH ANALISA FAECES Pencernaan
G6PD Neonatus - #disk Faeces Rutin Amylase Pancreatic Subtipe Limfosit : CD 4 Darah Samar Amylase Pancreatic Urine Subtipe Limfosit : CD 8 ProHealthy Gut Amylase Pancreatic Urin 24 Jam Subtipe Limfosit : CD
34 (Dharmais) URINALISA Lipase
Leukemia
Phenotyping(RSCM) Urine Rutin Fecal Calprotectin GENOMIC Urine Rutin (UF)
ANTIOKSIDANProsafe (PRN) Protein Total (
o) Urine sewaktu
/ 24 jam Status Antioksidan Total
Skin & Hair GENOMICS GENOMIC SEPSIS
TENSrisk
CArisk 2.0 Procalcitonin (PCT)
TENSrisk (add on)
CArisk 2.0 (Add on) GENOMIC
PWG DIARisk Prodia Nutrigenomics
(o) : urine 24 jam DIARisk (add on) Prodia Nutrigenomics (Add On) (*) : puasa 12 jam PharmacoGENOMICS VASCULArisk
(#) : persiapan pemeriksaan hubungi
petugas Lab. NeuroGENOMICS VASCULArisk (add on)
(***) : Tanggal Hari
Pertama Haid Terakhir SportDNA ImmuneRisk
(!) : isi FPP TDM Carisk hereditary (Hi
penetrance)
IMMUNErisk (add on)*) REVISI Eye GENOMICS
MOLEKULAR JANTUNG HEPATITIS
HBV-DNA (Real Time
PCR) CK HBsAg
HCV-RNA (Real Time
PCR) CK-MB (Massa) HBsAg Konfirmasi
HCV-RNA (Real Time
PCR) & HCV Genotipe Troponin I HBsAg Kuantitatif HCV Genotipe
(Sequencing) (**) hs-Troponin I (Kuantitatif) Anti HBs
HIV-1 RNA (PCR) LDH Anti-HBs pasca vaksinasi HPV-DNA High Risk (HC)
(#) Homocysteine (*) Anti-HBc
HPV-Genotype (#)
Triple Cardiac Marker (CK-MB, Troponin I, Myoglobin)
Anti-HBc IgM
MTB DNA (Real Time
PCR)
HBeAgDengue-RNA (Real Time
PCR) NT-proBNP Anti-HBe
CT/NG-DNA (Real Time
PCR) ST2 Anti-HCV
CMV-DNA (Real Time
PCR)
GINJAL-HIPERTENSI
Anti-HAV IgGProses slide HE
Urea N Anti-HAV IgMKreatinin
Anti HDV Total
Molekular
Farmakogenetik
Kreatinin UrineAnti HEV IgM
CYP2C19 - Genotipe *2,*3 Kreatinin Clearance ( o )
TORCH
Warfarin IndivTest (CYP2C9 & VKORCI1
Genotipe) Cystatin-C Anti-Toxoplasma IgA = Toxo Gondii
IgA
Molekular Onkologi
Asam Urat Anti-Toxoplasma IgG BCR-ABL Kualitatif Asam Urat Urine (º) Anti-Toxoplasma IgM BCR-ABL p210 Kuantitatif Albumin Urine Kuantitatif (AUK)(sewaktu/24 jam) Aviditas Anti-Toxoplasma IgG Mutasi JAK2 V617F b2-Microglobulin Anti-Rubella IgG
Mutasi EGFR Renin Activity Plasma,LC/MS/MS Anti-Rubella IgM
Mutasi EGFR ctDNA Aldosteron (PRN) Anti-CMV IgG
Ultrasensitive-Mutasi
EGFR ct-DNA ACTH (#*)Quest Anti-CMV IgM
OncoPrecise
VMA Urine (#º) FKUI Aviditas Anti-CMV IgGMolekular Lain-lain
Anti-HSV 1 IgGAnalisa Kromosom
Anti-HSV 1 IgM
APOE-Genotipe
Anti-HSV 2 IgG
Prodia PULS Cardiac
Test
Anti-HSV 2 IgMTelomere Analysis PENANDA TUMOR
Lain-lain
AFPMIKROBIOLOGI
Organic Urine Acid
CEA Kultur Urine + sens (Vitec)Very Long Fatty Acid
CA 19-9 Kultur Bahan Lain + resisAcylcarnitin
CA 72-4 Kultur Gall (Vitec)PIVKA
HE4 Kultur Darah + sens (Vitec)ADMA-SDMA
CA 125 Kultur Faeces + resis (Vitec)HE4+CA 125 (ROMA)
Kultur Vibrio
CA 15-3 Kultur Rectal Swab (Vitec)
PENY.MENULAR
SEKSUAL
Cyfra 21-1 Pengecatan GramVDRL/RPR NSE Candida (Mikroskopik)
TPHA SCC Trichomonas (Mikros)
Anti-Chlamydia
trachomatis IgG PSA
Kultur Cairan Tubuh
Anti-Chlamydia
trachomatis IgM Free PSA Kultur GO (Vitec)
TUBERKULOSIS
Anti-EBV VCA IgA** NB : Semua tarif Kultur berlaku sistem NON RETUR &
metode Vitec
IFN-Gamma ReleaseAssay (IGRA) Anti EBV EA IgA
OSTEOPOROSIS
BTA (mikroskopik) M2PK(Multilab,Dharmais) N-MID Osteocalcin Kultur BTA AFP + PIVKA-II (bundling) CTx (C-Telopeptide) (*) Adenosine Deaminase
(ADA)
INFEKSI LAIN REPRODUKSI - GESTASI ALERGI
Anti-Dengue IgG & IgM LH (#***) Eosinofil Absolut Dengue NS1 Antigen Anti-Mullerian Hormone (AMH) IgE Total
Anti Chikungunya IgM FSH (#***) IgE Spesifik Bulu Ayam (Biolisa)
Widal Prolactin (#) IgE Spesifik Cokelat
Anti-Salmonella typhi IgM Progesteron (***) IgE Spesifik Daging Ayam
Anti EBV CA IgM 17-OH Progesteron (LC-MS/MS) IgE Spesifik Daging Babi (Biolisa)
Anti-EBV EA IgM/NUH Androstenedione (LC-MS/MS) IgE Spesifik Daging Kambing (Biolisa)
Rotavirus Antigen Stero Pro (LC-MS/MS) IgE Spesifik Daging Sapi (Biolisa)
Anti-Amoeba Estradiol (***) IgE Spesifik Debu Rumah
HpSA Estriol, LC/MS/MS, Serum IgE Spesifik Epitel Anjing Anti-H. Pylori IgG Estrogen Total (Quest) IgE Spesifik Epitel Kucing
Urea Breath Test b-HCG IgE Spesifik Epitel Tikus
Anti Leptospira IgM MS AFP (Maternal Serum) IgE Spesifik Gandum (Biolisa) Malaria (mikroskopik) Testosterone IgE Spesifik Ikan
Malaria Antigen SHBG IgE Spesifik Ikan Cod (Biolisa)
Microfilaria (mikroskopik) Free Testosteron Index IgE Spesifik Jamur Aspergillus Anti-HIV Testosteron Free & Total IgE Spesifik Jamur Penicillin Anti HIV 3 Metode Free Testosteron(QUEST) IgE Spesifik Kacang
Anti-HIV Konfirmasi Free testosterone & bio IgE Spesifik Kacang Kedelai (Biolisa)
Clostridium difficile
(GDH) DHEA - S IgE Spesifik Kapuk
Clostridium difficile
(Toksin A/B) Tes Kehamilan IgE Spesifik Kecoa
Anti SARS-CoV-2 IgM/IgG-
SD Biosensor-Tes Awal
HORMON LAIN IgE Spesifik Kepiting Anti SARS-CoV-2 IgM/IgG-
SD Biosensor-Tes Ulangan Cortisol (#) IgE Spesifik Kerang
Cortisol Saliva
IgE Spesifik Kotoran Burung (Biolisa)Cortisol-free (# o),urine IgE Spesifik Kuning Telur
LAIN-LAIN
PTH intact (*) IgE Spesifik Lobster (Biolisa)Analisa Sperma (#) IGF-1 IgE Spesifik Mucor (Biolisa)
Antibodi Sperma (#) Growth Hormone IgE Spesifik Nasi (Biolisa) Fragmentasi DNA
Spermatozoa (#) Gastrin - QUEST IgE Spesifik Orange (Biolisa) Analisa Batu Ginjal (FTIR)
TDM (#)(!)
IgE Spesifik Pisang (Biolisa) Analisa Batu Empedu Carbamazepin IgE Spesifik Putih TelurHLA-ABC Cyclosporin Parent IgE Spesifik Serpihan Kulit Kuda (Biolisa)
HLA-DR Digoxin IgE Spesifik Strawberry (Biolisa)
HLA-ABDR Lithium (NUH) IgE Spesifik Susu
HLA-C Phenobarbital IgE Spesifik Susu Sapi (Biolisa)
HLA-B27 Phenytoin/Dilantin IgE Spesifik Susu Soya (Biolisa)
Pap Smear (#) Tacrolimus IgE Spesifik Tomat (Biolisa)
Sitologi Serviks Berbasis
Cairan (SSBC) (#) Theophyllin IgE Spesifik Tuna (Biolisa) Rasio s-Flt1/PlGF Valproic Acid IgE Spesifik Tungau Debu Rumah NBS-Amino Acid (LC-
MS/MS)
IgE Spesifik Udang
Alpha - HBDH IgE Atopy (Panel Indonesia)
Diseksi janin IgE Atopy (Panel Pediatri)
IT Ratio IgG Food Sensitivity Profile
PEMERIKSAAN TIDAK
TERCANTUM DI FPP
REMATIK MIKRONUTRISI &LOGAM
BERAT
Amphetamin ASTO Vitamin A & E
Canabis RF Vitamin D 25-OH Total
Coccain CRP Kualitatif Mn, Serum
Cotinine
Anti-CCP IgG Fe, SerumMetamphetamine ANA (IF) & ANA Profile Co, Serum
Opiat ANA (IF) Cu, Serum
Benzodiazepine
ANA Profile Zn, SerumAsam Laktat (plasma) Panel ProALD Se, Serum
Napza Panel (5 analit) Anti Mitochondrial Antibody M2
(AMA M2) Cd, Whole Blood
Rumpel Leede AMA DAN ASMA IF Hg, Whole Blood
Fenilalanin neonatus
(GSP) - # diskon *) ANCA (IF)
Pb, Whole Blood 17-OH ProgesteronNeonatus (GSP) -#disk *) Sel-LE Fatty Acid PROfile
C3 Komplemen Omega PROfile
C4 Komplemen Panel Nutrisi Serum (Zn, Se, Mn, Cu, Fe, Co, V, Cr, Mo)
Anti-ds-DNA-NcX
Panel Anti Aging Serum & Whole Blood (Co, Zn, Fe, Hg, Pb, Cd, As, Se)
Acetylcholine Receptor Antibodies
(ACAB) Panel Toksik Serum dan Whole
Blood (As, Cd, Pb, Hg, Ni, Tl) Acetylcholine Receptor Blocking
Antibody
Panel Nutrisi dan Logam Berat, Serum & Whole Blood (Zn, Se, Mn, Cu, Fe, Co, V, Cr, Mo, Hg, Pb) Acetylcholine Receptor Modulating
Antibody
Panel Nutrisi dan Logam Berat, Serum & Whole Blood-2 (Zn, Se, Mn, Cu, Fe, Co, Cd, As, Hg, Pb)